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elva

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First off, thanks so much for taking time to read through my lengthy post. So...a persistent and continuous twitch between the thumb and index finger on the right brought me to the GP (I am 37 years old) - that specific twich stopped after 2 weeks. Very frequent (as in several per minute) twitches elsewhere (legs, hands, including moving fingers). At the time of the GP visit, I did not feel weakness, but (as I found out from the neuro later), his strength tests found weakness in the right hand - in the muscle that moves the pinky finger outward. I also have brisk reflexes. The GP did blood tests (all normal), and referred me to a neuro. At the neuro, a resident in her last year did all the neurological/strength testing, the doc just came in at the end. He agreed to do an NC/EMG the next day.

Before I bring up my concerns, let me say that this neuro is a general neuro (not neuromuscular), but he is board certified in Clinical Neurophysiology and Electrodiagnostic Medicine. He does EMGs in his office one afternoon a week, and does teach a fellowship student (post residency) in electrodiagnostic medicine.
This was my first EMG - so maybe I am worried about nothing...Btw, there was lots of talking and laughter during the exam.

The EMG part itself did not take all that long. All told, I was in there for about 1 hour 15 minutes total, the nerve conduction tests look longer than the EMG. He tested 5 muscles in the right arm, and 5 in the right leg.

1) The muscle that had been identified as weak in the exam was the one muscle where there were movements on the screen while I was supposed to be at rest. After pushing against the finger a couple of times, the neuro declared that was voluntary movement (I have since read up on this, and it seems that is normal procedure). However, I don't think he ever really observed that muscle at rest after that, or at least he did so for only a second or two).

2) He did not test the muscle that had had 2 weeks of continuous twitching - only 2 nearby muscles. (He claimed when asked that there were only a few spots to put needles in, but I don't think that's true)

2) The neuro inserted one needle per muscle, and at rest really did not look at the screen for very long. Maybe 10-15 seconds at the very most? Of course, I didn't time it, but it didn't feel very long (I read on this site that someone actually didn't get diagnosed on EMG until a neuro took longer to observe the muscles at rest - hence my concern).

3) The tibialis anterior had a fascis, no others found during the EMG. This is not really a concern...

4) When I was told to tighten my leg (calf muscle?), I cramped. Same with with another leg muscle (cramping was starting in the foot pretty much as soon as I had to tighten the muscles). So for 2 of the 5 leg muscles (the 2 with needles from the side/back), I cramped. Is this worrisome? I have found nothing regarding the significance of cramping during EMGs.

According to the neuro, there was no cause for the weakness in the pinky found. Since the twitching started about a month ago, my right ankle and knee and right wrist have been slightly achy and sore/fatigued, and subjectively weak. But that could be a coincidence, as I do carry my 17+ lb baby on that side up and down the stairs. I had the EMG about 2.5 weeks after the start of twiching, and about half a week after the onset of soreness/fatigue. Can I breathe a sigh of relief and forget about all of this, despite the clinical weakness, perceived weakness on the right side, and brisk reflexes, or should I insist on a second opinion? In short, can I trust this EMG?
 
The short answer: Probably.

The longer answer: If you don't believe the neurologist--see a neuromuscular specialist. IF that specialist finds abnormalities, they will do their own EMG.

My EMG in my legs caused severe spasms. And believe me, no one was laughing--especially me. It was painful. I won't do another one, personally. My neuromuscular specialist didn't trust the one done by the neuro and repeated her own--testing all 4 limbs.

It's VERY possible that you've strained a muscle with the baby lifting--or even that you have a neck issue (neck issues cause hand issues)

Hope that helps. (TWITCHING isn't ALS--it happens when the muscle is dying--and believe me, there is loss of function before that happens)

Try to relax. If symptoms persist--make an appt with a neuromuscular specialist.

Good luck
 
My first EMG was 2.5 hrs per limb and was dirty. My second opinion EMG was under 15 mins for entire body and was dirty. MND will show up before the patient notices symptoms. Agree if it gets worse, get a second opinion.
 
Elva,

My vote goes to the neurologist. But you probably wanted the other answer just to validate your already made decision. If you don't have faith in your doctor or how he does things, then you need to move on.

Just my 2 cents,
 
Sounds like your neurologist is right on the button. Everything he has done sounds fine. Can't work out why you would question his ability? From what you read? He did years of training.

He was correct about the muscles in your hand.....fancy that.
He has no need to do a 2.5 hr EMG as your hand was fine.

You ARE worried about nothing. Absolutely nothing. I have a few week fingers and do NOT have ALS. I have full time twitches and do NOT have ALS. I have had 7 EMGs and I am not an expert!
 
Thanks so so much for the responses everybody. The symptoms are subtle but hard to ignore, the pretty much constant twitching in weird places (I haven't had a single eyelid twitch, which I thought is a more typical location), and the 2-3 weeks of soreness which is hard to describe (sore joints, stiff fingers, easily fatigued, sometimes crampy without actual full-blown cramps, all on the right side), together with a small amount of clinical weakness I wasn't aware of . All of which can of course be attributed to benign causes.
Why was I worried about the EMG/neuro? The laughter/chatting during the exam (I don't recall any EMG noises), the fact that a resident did the neuro exam, the fact that he didn't look at the screen for a long time when at rest,...But it's really good to hear that you don't find anything out of the ordinary. Perhaps to a neuro experienced in EMG it was nothing but a bread and butter boring exam...I will ask my GP why he referred me to this guy in particular. Thanks so much for your input and time - it really is appreciated!
 
Gotta love the quality of graduates that the G o o g l e School of Medicine is turning out these days.
 
Ok trfogey I saw you had responded so I was reading the thread and comments and looking forward to seeing what you wrote. I literally laughed out loud at your humor.

Elva - I am not making light of your concern, the question is why would you not trust your Neuro after you touted his resume. I would breath a sigh of relief. If your "symptoms" worsen you can always go back to the doctor.

I would trust your doctor.
 
Thanks so so much for the responses everybody. The symptoms are subtle but hard to ignore, the pretty much constant twitching in weird places (I haven't had a single eyelid twitch, which I thought is a more typical location), and the 2-3 weeks of soreness which is hard to describe (sore joints, stiff fingers, easily fatigued, sometimes crampy without actual full-blown cramps, all on the right side), together with a small amount of clinical weakness I wasn't aware of . All of which can of course be attributed to benign causes.
Why was I worried about the EMG/neuro? The laughter/chatting during the exam (I don't recall any EMG noises), the fact that a resident did the neuro exam, the fact that he didn't look at the screen for a long time when at rest,...But it's really good to hear that you don't find anything out of the ordinary. Perhaps to a neuro experienced in EMG it was nothing but a bread and butter boring exam...I will ask my GP why he referred me to this guy in particular. Thanks so much for your input and time - it really is appreciated!

I'm going to be nice.

Eyelid twitches aren't common in ALS. I'm not going to ask where you got that one. If they are the diagnostic criteria, I'm a goner -- musta had ALS for about 20 years.

Sore and stiff joints are more in line with something that a Rheumy should look at. When we hurt--we feel weak. Pain is tiring. It really is.

I don't know if you use your hands a lot--or type a lot--but carpal or cubital tunnel are possible for the hand cramping?

Twitching--without correlating LMN signs on EMG are harmless. Fasciculation is often seen in BFS (see stickies)

Trfogey isn't a doctor--but he's VERY knowledgeable. One of the other people that answered you is a nurse married to a neurologist.

Remember the cardinal rules for ALS -- progression. Worsening symptoms. There are so many things that can mimic ALS it's not even funny. There are tons of things that have to be ruled out first.

One very common cause of spasms is potassium deficiency. Have it checked perhaps, if it hasn't been. Another potential and COMMON cause of weakness and some of your other symptoms is B-12 levels--easily treated--but one of the things that is ruled out before ALS can even be CONSIDERED, let alone diagnosed.

Relax. Chances are you have something very mild that can be easily treated if it gets worse.

Good luck to you
 
Ok trfogey I saw you had responded so I was reading the thread and comments and looking forward to seeing what you wrote. I literally laughed out loud at your humor.

TedH5,

Sometimes, less really is more. This seemed to be one of those occasions.
 
I'm going to be nice.

Eyelid twitches aren't common in ALS. I'm not going to ask where you got that one. If they are the diagnostic criteria, I'm a goner -- musta had ALS for about 20 years.

Good luck to you

Thanks notme: I meant of course that the eyelids are a common location for benign twitching.
From the comments of the neuro when setting up the NC/EMG test, I think they expected to find an ulnar nerve problem due to the pinky weakness - but none was found.
Blood tests already ruled out deficiencies of all sorts, including potassium, b12, magnesium, thyroid,...A deficiency is what I had expected when I started twitching.
Yes - I know the wait and see if it gets worse. But we are supposed to pack up and leave the country for a year in a couple of months...
Thanks again for your response.
 
Elva,

Do they not have doctors to where your going? I gather you're military...gather up your records so that you have them in hand and make copies for the doctors. Good Luck to you,
 
It doesn't take a neuromuscular specialist to read an EMG--your doc apparently specialized in this area--which takes extra coursework for the specialty. I'd believe the results.

IF--and that's a big IF- you have something sinister, it will progress before you leave the country.
 
Just another question: How warm (temperature wise) were your EMG labs? Above or at normal room temperature? I was quite cold, especially later on during the exam (and I did mention it to the neuro, but he just squeezed my foot)...And now I am reading that this can reduce or eliminate fibrillations and short waves. Yikes.
Thanks again, and sorry for taking your time yet again. I do appreciate all the responses.
 
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